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Exercise testing for non-invasive assessment of atrial electrophysiological properties in patients with persistent atrial fibrillation

Husser, Oliver; Husser, Daniela; Stridh, Martin LU ; Sörnmo, Leif LU ; Corino, Valentina D. A.; Mainardi, Luca T.; Lombardi, Federico; Klein, Helmut U.; Olsson, Bertil LU and Bollmann, Andreas LU (2007) In Europace 9(8). p.627-632
Abstract
Aims Experimental studies suggest that the autonomic nervous system modulates atrial refractoriness and conduction velocity in atrial. fibrillation (AF). These modulatory effects are, however, difficult to assess in the clinical setting. This study sought to non-invasively characterize in patients with persistent AF, the influence of autonomic modulation induced by exercise on atrial fibrillatory rate as marker of atrial refractoriness and to identify clinical and electrocardiographic predictors of atrial rate response. Methods and results In 24 patients (16 mates, mean age 60 +/- 13 years) with persistent AF (16 +/- 25 months), continuous ECGs were recorded during bicycle exercise testing. Fibrillatory rate (in fibrillations per minute,... (More)
Aims Experimental studies suggest that the autonomic nervous system modulates atrial refractoriness and conduction velocity in atrial. fibrillation (AF). These modulatory effects are, however, difficult to assess in the clinical setting. This study sought to non-invasively characterize in patients with persistent AF, the influence of autonomic modulation induced by exercise on atrial fibrillatory rate as marker of atrial refractoriness and to identify clinical and electrocardiographic predictors of atrial rate response. Methods and results In 24 patients (16 mates, mean age 60 +/- 13 years) with persistent AF (16 +/- 25 months), continuous ECGs were recorded during bicycle exercise testing. Fibrillatory rate (in fibrillations per minute, fpm) was assessed at baseline and immediately after termination of exercise with spatiotemporal QRST cancellation and time-frequency analysis. Ventricular response was characterized by time-domain HRV indices. Exercise had no influence on mean fibrillatory rate (409 +/- 42 vs. 414 +/- 43 fpm, P = NS). Seven patients responded to exercise with an increase in fibrillatory rate (26 10 fpm, P < 0.001 and three with a decrease (-21 +/- 8 fpm, P < 0.001), while the remaining 14 patients did not show a response. Responders' HRV indices changed in response to exercise similarly to that of non-responders. Their baseline fibrillatory rate was, however, lower than that of non-responders (387 +/- 18 vs. 425 +/- 48 fpm, P = 0.028). No other clinical or echocardiographic variable was associated with fibrillatory rate response. Twelve weeks after cardioverson, responders were more likely to remain in sinus rhythm than non-responders (88 vs. 46 %, P = 0.04). Conclusions Exercise-induced autonomic activation produces changes in atrial. etectrophysiological properties that can be detected by time-frequency analysis. Higher baseline fibrillatory rates are associated with an impaired atrial response to exercise that suggests advanced electrical remodelling and reduced sensitivity to autonomic stimuli. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
exercise testing, ECG, autonomic nervous system, atrial fibrillation
in
Europace
volume
9
issue
8
pages
627 - 632
publisher
Oxford University Press
external identifiers
  • wos:000249915000014
  • scopus:34547936745
ISSN
1532-2092
DOI
10.1093/europace/eum124
language
English
LU publication?
yes
id
6050a958-93f8-4b02-8dc3-3d6e67087e9d (old id 655731)
date added to LUP
2007-12-11 13:04:06
date last changed
2017-03-19 03:27:46
@article{6050a958-93f8-4b02-8dc3-3d6e67087e9d,
  abstract     = {Aims Experimental studies suggest that the autonomic nervous system modulates atrial refractoriness and conduction velocity in atrial. fibrillation (AF). These modulatory effects are, however, difficult to assess in the clinical setting. This study sought to non-invasively characterize in patients with persistent AF, the influence of autonomic modulation induced by exercise on atrial fibrillatory rate as marker of atrial refractoriness and to identify clinical and electrocardiographic predictors of atrial rate response. Methods and results In 24 patients (16 mates, mean age 60 +/- 13 years) with persistent AF (16 +/- 25 months), continuous ECGs were recorded during bicycle exercise testing. Fibrillatory rate (in fibrillations per minute, fpm) was assessed at baseline and immediately after termination of exercise with spatiotemporal QRST cancellation and time-frequency analysis. Ventricular response was characterized by time-domain HRV indices. Exercise had no influence on mean fibrillatory rate (409 +/- 42 vs. 414 +/- 43 fpm, P = NS). Seven patients responded to exercise with an increase in fibrillatory rate (26 10 fpm, P &lt; 0.001 and three with a decrease (-21 +/- 8 fpm, P &lt; 0.001), while the remaining 14 patients did not show a response. Responders' HRV indices changed in response to exercise similarly to that of non-responders. Their baseline fibrillatory rate was, however, lower than that of non-responders (387 +/- 18 vs. 425 +/- 48 fpm, P = 0.028). No other clinical or echocardiographic variable was associated with fibrillatory rate response. Twelve weeks after cardioverson, responders were more likely to remain in sinus rhythm than non-responders (88 vs. 46 %, P = 0.04). Conclusions Exercise-induced autonomic activation produces changes in atrial. etectrophysiological properties that can be detected by time-frequency analysis. Higher baseline fibrillatory rates are associated with an impaired atrial response to exercise that suggests advanced electrical remodelling and reduced sensitivity to autonomic stimuli.},
  author       = {Husser, Oliver and Husser, Daniela and Stridh, Martin and Sörnmo, Leif and Corino, Valentina D. A. and Mainardi, Luca T. and Lombardi, Federico and Klein, Helmut U. and Olsson, Bertil and Bollmann, Andreas},
  issn         = {1532-2092},
  keyword      = {exercise testing,ECG,autonomic nervous system,atrial fibrillation},
  language     = {eng},
  number       = {8},
  pages        = {627--632},
  publisher    = {Oxford University Press},
  series       = {Europace},
  title        = {Exercise testing for non-invasive assessment of atrial electrophysiological properties in patients with persistent atrial fibrillation},
  url          = {http://dx.doi.org/10.1093/europace/eum124},
  volume       = {9},
  year         = {2007},
}